Study Questions:

What is the association between specific dietary patterns and the presence and extent of subclinical atherosclerosis in a population of asymptomatic middle-aged adults?

Methods:

The PESA (Progression of Early Subclinical Atherosclerosis) study enrolled 4,082
asymptomatic participants 40-54 years of age (mean age, 45.8 years; 63% male) to evaluate the presence of subclinical atherosclerosis and the lifestyle-related determinants, including diet, on atherosclerosis onset and development. This included a coronary artery calcium (CAC) score and ultrasound imaging of atherosclerotic plaque of multiple vascular territories. Adjusted logistic regression models were used to assess the relationship between dietary patterns and the presence of any plaque and CAC score ≥1, and age, sex, energy intake, socioeconomics, physical activity, sleep, business travel, and cardiovascular disease (CVD) risk factors.

Results:

Most PESA participants follow a Mediterranean (40% of participants) or a Western
(41%) dietary pattern. A new pattern, identified among 19% of participants, was labeled as a social-business eating pattern, characterized by a high consumption of red meat, pre-made foods, snacks, alcohol, and sugar-sweetened beverages and frequent eating-out behavior. Men dominated the Western and social-business patterns. Participants following the social-business pattern more likely had a significantly worse CVD risk profile including inflammatory markers. After adjustment for risk factors, they had an increased odds of subclinical atherosclerosis (odds ratio, 1.31; 95% confidence interval, 1.06-1.63) compared with participants following a Mediterranean diet.

Conclusions:

A new social-business eating pattern characterized by high consumption of red and processed meat, alcohol, and sugar-sweetened beverages, and by frequent snacking and
eating out, as part of an overall unhealthy lifestyle, is associated with an increased prevalence, burden, and multisite presence of subclinical atherosclerosis.

Perspective:

This important clinical observation study using cluster-derived diet patterns supports the disappearance of the US business practice of salespersons and executives doing deals in a 2-3 martini 2-hour lunch, which in this Madrid, Spain bank employee group was also associated with more smoking, salt consumption, and total kcal intake. That the increase in preclinical coronary atherosclerosis was found in well-educated middle to high income office workers, lends credence to the evidence that atherosclerosis can be reduced by increasing the components of the Mediterranean diet and reducing processed meats, high intake of saturated fats, and fructose-sweetened beverages.